Spontaneous Eye Tearing: Excessive Tears & Epiphora

Excess tearing can be due to a large number of different eye problems, both simple and complex. It is a very common complaint of patients and in complicated cases, it may take several visits and require several attempts at different remedies before the symptoms are satisfactorily controlled.

Epiphora is the medical term used when the excess tears spill over the eyelid and run down the face. Usually excessive tearing can be controlled medically but sometimes, it may be necessary to treat surgically. Fortunately, in these cases, there is a high degree of success and of patient satisfaction.

Dry Eye Syndrome

One of the most common causes of excess tearing in older adults is dry eye syndrome. Ironically, one of the symptoms of dry eye can be excessive watering of the eyes. The watering is a natural reflex caused by irritation to the eye because the composition of the tears is incorrect. Normal tears are comprised of three layers: the lipid, or oil layer; the lacrimal, or watery layer; and the mucoid, or mucus layer. All three layers of tears are necessary for proper lubrication. Persons with dry eye syndrome have tears that are mostly water and evaporate quickly, providing little protection for the eye.

Epiphora

Epiphora is an overflow of tears, usually caused by insufficient drainage of the tear film from the eye. The most common cause is looseness of the lower eyelids which prevents the eye from draining the tears properly. The second most common cause is a blockage of the lacrimal (tear) ducts located next to the nose. However, epiphora may also result from the excessive production of tears.

Other causes of excessive tearing are may be corneal disorders, dry eye syndrome, allergies, inflammation of the eyelid (blepharitis), weakness of facial muscles as the result of a stroke, and eyelashes rubbing on the cornea. None of these causes are related to tear duct blockage.
Epiphora is a symptom rather than a disease and may be caused by a variety of conditions.

The purpose of normal tears is to lubricate, nourish, and protect the eye from dust and other irritants. Spread by blinking (about every six seconds), tears keep the surface of the eye optically clear and smooth, and also protect from infection. Tears flow into the eye through ducts from tiny glands located under the upper eyelids and drain from the eye through the puncta (singular: punctum), which are small openings near the nose.

A portion of tears evaporates, but the excess normally drains into the nose via the lacrimal canals and then into the throat or out through the nostrils. These types of tears are made continuously and are known as basal cell secretions. Reflex tears, on the other hand, are those produced in response to emotions or when the eye is very irritated. These are produced by a separate gland called the lacrimal gland. Basal tearing is more important for the health of the eye, but the volume of tears produced by the reflex mechanism is larger.

It is important to differentiate between chronic epiphora, acute epiphora, and normal tearing. Chronic epiphora results from a long-standing or continuous disorder, while acute epiphora usually results from a temporary condition such as a foreign body in the eye or environmental factors such as wind, pollen, eyestrain, emotional stress, and sleep deprivation. The chronic variety nearly always requires treatment by a professional, while acute epiphora may or may not require treatment, depending on the severity of the condition. Everyone experiences an occasional overflow of normal tears.

Occasionally children are born with congenital epiphora, which is usually related to incomplete development of the tear duct drainage system. This disorder often disappears without treatment during the first six months of life. If it remains, consult an oculofacial to determine the cause and treatment.

What are the symptoms of epiphora?

Symptoms of epiphora include excessive tearing, matting of the eyelashes, and mucous or pus-like discharge from the puncta. Excess tearing can cause infection and, if left untreated, could be detrimental to good vision. Eyelid irritation is common because the area remains wet. Patients often complain because they must constantly wipe their eyes.

When the epiphora is caused by dry eye, a variety of measures can be employed to alleviate the symptoms. Artificial tears in the form of eye drops are the most common treatment. Many of these eye drops are available over-the-counter and are used to lubricate the eye. Sometimes the drops that are free of preservatives work better than the preserved drops although they usually cost more. The first prescription eye drop for the treatment of dry eye syndrome was recently developed. Restasis may be helpful when the symptoms of dry eye syndrome persist despite frequent use of artificial tears. A humidified environment also helps in dry eye treatment by adding moisture to the air and by helping prevent the evaporation of tears. Frequent blinking to spread tears is helpful, and avoiding smoke, wind, and other irritating conditions may provide relief.

If the epiphora is due to eyelid inflammation (blepharitis), corneal disorders or eye allergies (allergic conjunctivitis), the oculofacial specialist can control your symptoms with the proper use of prescription eye drops and other medical treatments.

Because epiphora can be caused by a wide variety of disorders, a proper diagnosis by an oculofacial specialist is necessary before treatment begins. If the excessive tearing results from a punctal obstruction, the most common treatment is for the doctor to open (dilate) the puncta and wash it out (irrigate). This is a simple in-office procedure, but is not a permanent solution and must be repeated several times a year.

An obstruction of the nasolacrimal duct (a tear duct that ends in the mucous membrane of the nose) is often treated by a procedure called a dacryocystorhinostomy (DCR). During the DCR procedure, the obstruction in the duct is bypassed and a new tear duct is created. Fortunately, this procedure has a very high rate of success when performed by an experienced eye and facial specialist.

Final Reminders

To effectively treat excessive tearing and epiphora often requires a special understanding of the anatomy and pathophysiology of the eyelid and of the lacrimal (tear) system. Fellowship in the American Society of Oculofacial Plastic and Reconstructive Surgery (ASOPRS) indicates that the surgeon has greatest specialized training and expertise in this subspecialty.

If you have excessive tearing or epiphora, please contact Dr. Kass who is fully trained to treat this problem and has been in practice in Tampa Bay for over 27 years.